Digital Care Management: Why It’s Falling Short—and What’s Next

50 health plan execs reveal the biggest gaps—and their boldest next moves

Digital care management (DCM) tools were supposed to deliver scalable, personalized, cost-saving care. But most plan leaders say they’re missing the mark. In this new report, health plan leaders reveal:

  • Why only 8% say their tools meet members where they are
  • Where AI is poised to make the most significant leap
  • Why data gaps—not dollars—are holding back outcomes
  • 6 strategic gaps derailing DCM programs today
  • And, what it takes to build the intelligent health plan

Download the report to see where you stand—and what’s next.

Overview

Overview

Is your health plan meeting its care management (CM), utilization management (UM), and population health management (PHM) goals? If not, you’re not alone.

A new independent survey of 53 health plan leaders finds that many are struggling with ineffective tools that prevent them from fully integrating the growing influx of member data—medical, social, behavioral, genetic—into their workflows. As a result, legacy tools are hindering health plans from strategically leveraging data to reduce costs, improve outcomes, and streamline efficiencies.

Our latest report, based on the survey findings, further explores what is really required to drive impactful changes to UM, CM, and PHM programs.

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53 Leaders Surveyed

Regional payer 0

Gov't program plan (Medicare Advantage, Managed Medicaid, or both) 0

National payer 0

Managed services organization 0

Provider sponsored health plan PPS/ Payvider 0

TPA- Medicare or Medicaid 0

Tech-enabled and/or venture-backed health plan 0

Preview: The State of Utilization Management

One troubling finding: Just one-third of health plan execs say their UM tools are “very effective” at providing all of the data necessary for timely review and approval.

Clearly legacy UM tools are not as effective as health plans need them to be – and there is room for improvement when it comes to identifying health events in time to impact utilization of services and minimize provider abrasion.

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Leaders’ Frustrations with Legacy UM Tools:

Inefficient workflows 0

High costs associated with data problems 0

Provider abrasion 0

Staff complaints 0

Member complaints 0

Lack of coverage across member base 0

Why? Fragmentation and Lack of Integration

Data is fragmented 0

Data doesn't currently flow into workflows 0

Data integration is burdensome 0

Data is siloed 0

Software is cumbersome 0

Ease of use of the tool 0

Lack of data transformation 0

Data is inaccessible 0

Legacy UM tools are just not easy to use, and, in general, the UM process lacks efficient automation.

Given the critical role Utilization Management processes fill for health plans, these legacy solutions must be improved with strategic data use, AI, and automation to sustain member engagement, reduce costs, and improve health outcomes.

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Preview: The State of Care Management

The Biggest Barriers to Member Engagement

Lack of member engagement tools 0

Lack of personalization for members 0

Lack of ability to react in real time 0

Too much lag time between health event and ability to intervene 0

Lack of member self-service tools 0

Lack of visibility to member health journeys 0

The research suggests that implementing updated technology that provides quicker access to data and insights would significantly enhance CM. Today’s care management technologies, strategies, and workflows are inadequate for members’ quickly evolving and increasingly complex needs.

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Care managers need resources and insights that enable them to engage members at the health inflection point rather than 90 days after the fact. And they need the ability to create workflows based on member preferences, digital member assessments, and more.

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Execs Agree. A Holistic View of Members on their Care Journey is Very Important

Moderately important 0

Very important 0

Webinars

The Year Ahead in Care Management, Utilization Management, and Population Health was the inaugural webinar in Medecision’s new monthly series. The webinar features four expert speakers who share insights from our recent survey of health plan leaders.

Watch Playback

Our February webinar, The State of Utilization Management in 2024, covers the top barriers to UM today – and how healthcare leaders can overcome those challenges to optimize UM. 

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Our March webinar, The Top Care Management Barriers – And How To Tackle Them, covers the current state of care management, including the top barriers and how organizations can break through them.

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Our May webinar, Updates from Inside the Beltway: Analyzing Health Policy Activity and Trends in an Election Year, is presented by Maverick Health Policy. Our panel of Washington, D.C.-based experts will dissect the latest developments and forecast what these mean for the future of healthcare.

Watch Playback

Medecision invites interested parties to register for our upcoming webinars to discuss learnings from our exclusive research.

Webinar Series

Resources

Data Platform Blog Graphics-06
ARTICLE

Seizing the Opportunities With A Modern Health Data Platform

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ARTICLE

The Modern Data Platform in Action

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ARTICLE

Communicating The Benefits of A Modern Health Data Platform

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PODCAST

Medecision Podcast

Expert perspectives on the hot topics in healthcare.

 

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